A 60-year-old patient with gastric adenocarcinoma on CT has a mass in the distal stomach with a single regional lymph node enlarged at 1.5 cm, no distant metastasis. EUS confirms T3 N1 M0 staging. As per current guidelines, the optimal pre-operative strategy is:
- A Upfront total gastrectomy followed by adjuvant chemotherapy
- B Chemoradiotherapy followed by gastrectomy
- C Perioperative FLOT chemotherapy (pre- and post-operative) followed by gastrectomy with D2 lymphadenectomy ✓
- D Upfront subtotal gastrectomy; perioperative chemotherapy is not indicated for N1 disease
Correct answer: C. Perioperative FLOT chemotherapy (pre- and post-operative) followed by gastrectomy with D2 lymphadenectomy
Explanation
For resectable gastric cancer ≥T2 or N+, perioperative chemotherapy with the FLOT regimen (docetaxel, oxaliplatin, leucovorin, 5-FU) significantly improves R0 resection rates and overall survival compared to surgery alone, as demonstrated in the FLOT4 trial which superseded the ECF/ECX MAGIC regimen. The operation of choice for T3N1 distal gastric cancer is subtotal (or total) gastrectomy with D2 lymphadenectomy (removal of N1 and N2 nodal stations). Chemoradiation alone without perioperative chemotherapy is not standard in the perioperative context.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.